Healthcare Provider Details

I. General information

NPI: 1295719466
Provider Name (Legal Business Name): BRADLEY HENDRICKS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 07/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1273 W 12600 S 402
RIVERTON UT
84065-7111
US

IV. Provider business mailing address

13192 S MIDLAKE CT
DRAPER UT
84020-7829
US

V. Phone/Fax

Practice location:
  • Phone: 801-254-4600
  • Fax: 801-254-9670
Mailing address:
  • Phone: 801-243-9181
  • Fax: 801-254-9670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2726151202
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: